WAIVER OF RIGHTS AND INTERESTS

KNOW ALL MEN BY THESE PRESENTS:

I / We _____________________________________________________________________________________________
_________________________________________________________________________________________________________,
Philippines, after having sworn to in accordance with law, hereby depose and say that:
I/We am/are the buyer(s) of _____ parcel(s) of subdivision lot(s) known as _______________, with an area of
__________ sq. m., of the subdivision project known as PROVIDENCE-ILOILO, situated at Balabag, Pavia, ILOILO, Philippines.
I/We have executed a Contract to Sell with the St. Rafael Development Corporation, the developer of PROVIDENCE-ILOILO in
connection with
the
aforementioned purchase of Lot(s) _______________; which Contract to Sell is dated
____________________, and entered into the Notarial Books of _____________________________ as Doc. No. __________ ;
Page No. __________; Book No. __________; Series of __________;
I/We am/are no longer interested in pursuing the acquisition of the aforementioned parcel(s) of subdivision lot(s), including
any of the improvement(s) standing thereon, and decided to WAIVE and TRANSFER all my/our rights and interest in the
aforementioned parcel of land in favor of ________________________________, of legal age(s), Filipino(s), and resident(s) of
_____________________________________________________________________________, Philippines.
and

I/We hereby declare that the above-mentioned property is subject to the provisions of the Contract to Sell aforementioned,
has
outstanding
amortizations
and
obligations
as
provided
therein.
I/We
understand
that

________________________________ shall assume responsibility over the terms and conditions of the aforementioned
Contract to Sell, including the payment of any and all obligations pertaining thereto.
I/We further waive(s) any and all claim that I/we may have against ST. RAFAEL DEVELOPMENT CORPORATION by reason
of this waiver, and holds any and all of its directors, officers or employees free from any and all liability arising out of the Contract to
Sell, as well as by reason of this waiver and transfer. I/We understand that this waiver and transfer of rights is still subject to the
approval and consent of ST. RAFAEL DEVELOPMENT CORPORATION.
IN WITNESS WHEREOF, the parties hereby affix their respective signatures on this ______ day of ___________________
at Iloilo City, Philippines.
__________________________________
Transferor

__________________________________
Transferor

CTC No. _______________________

Issued on _______________________
Issued at _______________________

CTC No. _______________________

Issued on _______________________
Issued at _______________________

We accept:
__________________________________
Transferee

__________________________________
Transferee

CTC No. _______________________

Issued on _______________________
Issued at _______________________

CTC No. _______________________

Issued on _______________________
Issued at _______________________
With Our Conformity:

MARY ROSALIND T. MAGALONA

ST. RAFAEL DEVELOPMENT CORPORATION
Witnesses:
__________________________________
Witness

__________________________________
Witness
ACKNOWLEDGMENT

REPUBLIC OF THE PHILIPPINES

)
CITY OF ILOILO
)
x--------------------------------------x

s.s.

BEFORE ME a Notary Public for the

______________________________________________, personally appeared
____________________________________, who are personally known to me/who exhibited before me a competent proof of
his/her/their identities (___________________), as well as their Community Tax Certificates, as above-stated, known to me to be
the same persons who executed the foregoing instrument and that they acknowledge before me that the same was their own free
and voluntary act and deed.
The instrument, consisting one (1) page, including this page where the acknowledgment is found, and has been signed by
the parties and their respective witnesses on each and every page thereof, refers to a Deed of Assignment with Waiver of Rights and
Interests.
WITNESS MY HAND AND SEAL on this _____ day of ___________________ at ______________________, Philippines.
Doc. No.
Page No.
Book No.
Series of

__________;
__________;
__________;
__________.

To be executed by client when

the property will be transferred
to another person/buyer